Skip to Main Content

++

Vestibular schwannomas (acoustic neuromas) account for 80% of all lesions of the cerebellopontine angle (CPA). This chapter discusses some of the other common neoplasms (meningiomas and epidermoid cysts) as well as uncommon tumors of the CPA that commonly present with injury to the cochlear–vestibular system. Each of these tumors has a similar clinical presentation; they are primarily differentiated by their imaging characteristics.

++

The CPA consists of a potential space filled with cerebrospinal fluid (CSF) in the posterior cranial fossa bounded by the temporal bone, the cerebellum, and the brainstem. The CPA is traversed by cranial nerves V–XI and most prominently the facial (CN VII) and vestibulocochlear (CN VIII) nerves. CPA tumors account for 10% of all intracranial tumors (Table 62–1). Nearly 90% of all CPA tumors include vestibular schwannomas (acoustic neuromas) and meningiomas. Other CPA lesions include congenital rest lesions (eg, epidermoid cysts, arachnoid cysts, and lipomas), schwannomas of other cranial nerves, intra-axial tumors, metastases, vascular lesions (eg, paragangliomas and hemangiomas), and lesions extending from the skull base (cholesterol granulomas and chordomas). CPA lesions become clinically symptomatic by causing compression of the neurovascular structures in and around the CPA. The classic description of these symptoms initially includes unilateral hearing loss, vertigo, altered facial sensation, facial pain that later progresses to nystagmus, facial palsy, vocal cord palsy, dysphagia, diplopia, respiratory compromise, and death (Table 62–2).

++
Table Graphic Jump Location
Table 62–1. Lesions of Cerebellopontine Angle (CPA).
++
Table Graphic Jump Location
Table 62–2. CPA Syndrome.
Lalwani AK. Meningiomas, epidermoids, and other nonacoustic tumors of the cerebellopontine angle. Otolaryngol Clin North Am. 1992;25(3):707.  [PubMed: 1635871] (A thorough review of nonacoustic lesions of the cerebellopontine angle.)

++

Essentials of Diagnosis

++

  • Asymmetric (unilateral) sensorineural hearing loss, tinnitus, or both
  • More likely than vestibular schwannomas to have facial or trigeminal nerve findings, or both
  • Dural tail and calcification are distinctive on imaging.

++

General Considerations

++

Meningiomas are the second most common CPA tumors and account for 3–10% of neoplasms at this location. Compared with schwannomas, meningiomas are a more heterogeneous group of tumors with regard to pathology, anatomic location, and treatment outcome. Most of these tumors are benign and slow growing; 1% will become symptomatic. Meningiomas differ in pathogenesis, anatomic location, ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessSurgery Full Site: One-Year Subscription

Connect to the full suite of AccessSurgery content and resources including more than 160 instructional videos, 16,000+ high-quality images, interactive board review, 20+ textbooks, and more.

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessSurgery

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.